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June 3, 2020 by APA Psychiatric News Alert

Use of Seclusion, Restraint in Hospitals Drops, But Better Data Needed to Get Complete Picture

Rates of seclusion and restraint at American hospitals, including psychiatric hospitals, fell between 2013 and 2017, at least among those with the highest rates. For-profit hospitals appear to use seclusion and restraint much less than nonprofit and government-owned facilities, according to a report in Psychiatric Services in Advance.

But there continues to be enormous variability in the use of seclusion and restraint across hospitals. Moreover, reporting of data on seclusion and restraint use is marred by errors and lack of detail, including data on patient characteristics.

Public reporting of such data is intended to allow patients, families, and other stakeholders to compare hospitals and provides an incentive for hospitals to improve quality of care. “These benefits, however, can be realized only to the extent that the data collected and reported are accurate and complete,” wrote Vincent S. Staggs, Ph.D., of the University of Missouri-Kansas City.

He looked at rates of seclusion and restraint at 1,642 acute care and psychiatric facilities using the Centers for Medicare and Medicaid Services’ (CMS) Hospital Compare website. Staggs compared three types of hospitals—for-profit, nonprofit, and government-owned.

Among facilities with the highest rates of seclusion and restraint, those rates dropped by 18% to 32% between 2013 and 2017.

In 2017, two-thirds of hospitals reported seclusion rates of 0.09 hours or less per 1,000 patient-hours, and two-thirds reported restraint rates of 0.15 hours or less per 1,000 patient-hours. But 10% of hospitals reported rates roughly five times as high as these.

For-profit hospitals had markedly lower rates of seclusion and restraint than government and nonprofit hospitals.

Staggs found significant errors in the aggregated statistics, and a major conclusion of the study is the urgent need for more rigorous and detailed data. For instance, the data on Hospital Compare do not take into account patient-level data—such as severity of illness and other patient characteristics—that may help explain the differences in rates among hospitals.

Nor are there separate data on duration and on frequency of the use of seclusion and restraint. The statistic on “hours per 1,000 patient hours” currently reported by hospitals combines frequency and duration in such a way that obscures when a hospital may be outside the norm—either higher or lower—with regard to frequency and/or duration.

“As a potential resource for health care consumers, patient safety organizations, regulatory agencies, and researchers, these data deserve more attention and further development,” Staggs wrote. “[D]ata reporting to CMS should be made more rigorous and be expanded to include frequency of seclusion and restraint use and duration of seclusion and restraint episodes.”

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